Vacuum extraction in fetal macrosomia and risk of neonatal complications: a population‐based cohort study

Åberg, Katarina; Norman, Mikael; Pettersson, Karin; Ekéus, Cecilia

doi:10.1111/aogs.12952

Cited by 27 publications

(42 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although it is beyond the scope of this review to identify the underlying cause of the reduced instrumental delivery, macrosomia has been identified as a risk factor for the use of forceps or vacuum extraction 112. Previous work has identified that prenatal exercise reduces the odds of fetal macrosomia by 31%,113 and as a result, may reduce the risk for instrumental delivery.…”

Section: Discussionmentioning

confidence: 99%

Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

et al. 2018

View full text Add to dashboard Cite

ObjectiveTo perform a systematic review of the relationships between prenatal exercise and maternal harms including labour/delivery outcomes.DesignSystematic review with random effects meta-analysis and meta-regression.DatasourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]) and outcome (preterm/prelabour rupture of membranes, caesarean section, instrumental delivery, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms (author defined) and diastasis recti).Results113 studies (n=52 858 women) were included. ‘Moderate’ quality evidence from exercise-only randomised controlled trials (RCTs) indicated a 24% reduction in the odds of instrumental delivery in women who exercised compared with women who did not (20 RCTs, n=3819; OR 0.76, 95% CI 0.63 to 0.92, I 2= 0 %). The remaining outcomes were not associated with exercise. Results from meta-regression did not identify a dose–response relationship between frequency, intensity, duration or volume of exercise and labour and delivery outcomes.Summary/conclusionsPrenatal exercise reduced the odds of instrumental delivery in the general obstetrical population. There was no relationship between prenatal exercise and preterm/prelabour rupture of membranes, caesarean section, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms and diastasis recti.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Third, the criteria by which the women underwent one or another type of instrumentation (vacuum or forceps) was based on the obstetricians' experience and skill [50][51][52] (only five obstetricians participated in our study). First, only Malmström vacuum and Kielland forceps were used for the deliveries; therefore, the results obtained should not be generalized to all types of instrumental deliveries.…”

Section: Malmström Vacuum and Kielland Forceps Deliveriesmentioning

confidence: 99%

“…Second, the characteristics of the instrumentation included in our study, such as the station and fetal head position, were limited, and other factors, such as rotation or no rotation of the fetal head, should be evaluated in future studies. Third, the criteria by which the women underwent one or another type of instrumentation (vacuum or forceps) was based on the obstetricians' experience and skill [50][51][52] (only five obstetricians participated in our study). The experience of our obstetricians could have influenced our final results.…”

Section: Ta B L E 3 Levator Ani Muscle Injury and General Levator Hiamentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Abbreviations: CI, confidence interval; LAM, levator ani muscle; OR, odds ratio. AbstractIntroduction: Forceps delivery is associated with a high rate of levator ani muscle (LAM) trauma (avulsion) at 35%-65% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and LAM avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of LAM avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation. Material and methods: Prospective, observational study, including 263 nulliparous women, who underwent an instrumental delivery with either Malmström vacuum or Kielland forceps. The characteristics of the instrumentation, position (anterior position and other position) and height of the fetal head at the moment of instrumentation (low instrumentation [vertex at +2 station] and mid-instrumentation [head isinvolved but leading part above +2 station]) were assessed. Evaluation of LAM avulsion was performed at 6 months postpartum by three-/four-dimensional transperineal ultrasound. Using the multi-view mode, a complete avulsion was diagnosed when the abnormal muscle insertion was identified in all three central slices, that is, in the plane of minimal hiatal dimensions and the 2.5-mm and 5.0-mm slices cranial to this one. To detect a 30% or 15% difference in the LAM injury rate, with 80% power and 5% α-error, we needed, respectively 42 and 99 women per study group.Results: In all, 263 nulliparous individuals have been evaluated (162 vacuum deliveries, 101 forceps deliveries). Instrumentation in an occipito-anterior position was more frequent in vacuum deliveries (75.3% vs 56.4%, P = .002), whereas other positions were more frequent in the forceps deliveries group (24.7% vs 43.6%). No statistically significant differences were noted regarding the height of the fetal head at the moment of instrumentation. No statistically significant differences were found in the presence of LAM avulsion (41.4% vs 38.6%) between vacuum and forceps deliveries.The univariate analysis of the crude odds ratio was 1.17, 95% CI 0.67-1.98, P = .70 for

show abstract

“…We thank Dr. McQuivey for his comments (1) and interest in our work (2). Dr. McQuivey's point that the Swedish Medical Birth Register lacks detailed information is well-taken and causal relations among vacuum extraction, birthweight and neonatal complications are difficult to prove using our study design.…”

Section: Sirmentioning

confidence: 99%

Vacuum extraction in fetal macrosomia: registry data are useful

Åberg

Norman

Pettersson

et al. 2017

Acta Obstet Gynecol Scand

Self Cite

View full text Add to dashboard Cite

Vacuum extraction in fetal macrosomia and risk of neonatal complications: a population‐based cohort study

Abstract: Vacuum extraction is a risk factor for serious neonatal complications, in particular when used in macrosomic fetuses.

Cited by 27 publications

References 31 publications

Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

Vacuum extraction in fetal macrosomia: registry data are useful

Contact Info

Product

Resources

About